Total hip arthroplasty through an anterior approach

Kyriakopoulos, Georgios; Poultsides, Lazaros; Christofilopoulos, Panayiotis

doi:10.1302/2058-5241.3.180023

Cited by 47 publications

(54 citation statements)

References 88 publications

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“…The thickness of the cement mantle is dependent on several parameters. The anatomy of the femoral bone [ 20 ], the surgical approach [ 2 ], the design and size of implant [ 27 ], the cementing technique [ 20 ], use of a centralizer [ 28 ], the somatometric patient characteristics [ 29 ], the experience of the surgeon, and choice of the appropriate instruments [ 21 ] are important to achieve a cement mantle thickness greater than 2 mm.…”

Section: Discussionmentioning

confidence: 99%

“…The outcomes of cemented THA and the integrity of the femoral cement mantle using the DAA have not been reported in large numbers [2]. Consequently, it is unclear whether the DAA technique detrimentally affects the femoral stem cement mantle integrity.…”

Section: Introductionmentioning

confidence: 99%

“…The direct anterior approach (DAA) is a well-established muscle-sparing approach to the hip joint, which is used increasingly worldwide [ 1 ]. It can be performed with or without use of a traction table in the lateral or supine position [ 2 ]. Total hip arthroplasty (THA) utilizing the DAA is associated with favorable functional outcomes, especially during the initial postoperative period [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…It can be performed with or without use of a traction table in the lateral or supine position [ 2 ]. Total hip arthroplasty (THA) utilizing the DAA is associated with favorable functional outcomes, especially during the initial postoperative period [ 2 , 3 ]. One aspect of this technique that has been questioned is the ability of the surgeon to adequately approach the femoral canal [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Quality of the femoral cement mantle in total hip arthroplasty using the direct anterior hip approach

et al. 2020

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Background: Limited literature exists concerning the femoral cement mantle quality that can be achieved through an anterior approach in total hip arthroplasty (THA). We radiologically evaluated the quality and thickness of the femoral cement mantle in patients undergoing THA utilizing the direct anterior approach (DAA). Methods: Immediate postoperative anteroposterior and lateral radiographs of 116 consecutive patients who underwent hybrid or fully cemented THA using the DAA and cemented Quadra-C stem (Medacta, International, SA, Switzerland) were assessed by 2 arthroplasty surgeons blinded to the study. Surgical indications were hip osteoarthritis or subcapital hip fracture. The cement mantle and stem alignment were evaluated using the Barrack classification and Khalily methods, respectively. After calibration of radiographs, the thinnest part of the cement mantle per Gruen zone was recorded. Parameters were compared between obese and nonobese patients. Results: Agreement between raters was substantial for the cement quality in anteroposterior (k ¼ 0.707, P .001) and moderate for lateral radiographs (k ¼ 0.574, P 001). The cement mantle was graded A in 39.25%, B in 53.0%, and C in 7.75% of anteroposterior radiographs and similarly for lateral radiographs (40.1% A, 51.75% B, 9.5% C). 93% of stems had neutral alignment. The mean thinnest cement mantle (P ¼ .237) and incidence of inadequate cement mantle (<2 mm) per zone (P ¼ .431) were comparable between Gruen zones. The cement mantle quality (P ¼ .174) and inadequacy (P > .05) and stem alignment (P ¼ .652) were comparable between obese and nonobese patients. Conclusions: DAA enables correct implantation and effective cementation of straight femoral stems. A high-quality cement mantle can be achieved using DAA even in obese patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quality of the femoral cement mantle in total hip arthroplasty using the direct anterior hip approach

et al. 2020

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“…The direct anterior approach was initially described by Hueter in 1870 1 and subsequently popularized by Smith-Petersen et al 2 . Various surgical approaches have been applied over the last years for the total hip arthroplasty, but both surgeons and patients have demonstrated greater attention in the direct anterior approach, as it seems to offer rapid functional recovery of the patient, improved outcome in terms of hospitalization, muscle-sparing nature, pain and rehabilitation, and reduced risk of dislocation 3 . However, the steep learning curve, the difficulty of method application in obesity patients and the need for tendon and capsule further release remain some of the methods main disadvantages 4 .…”

Section: Ntroductionmentioning

confidence: 99%

AMIS Total Hip Arthroplasty using traction table: 5 years follow-up

Αποστολου¹,

Chatziprodromidou²

EPiC Series in Health Sciences

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Minimal invasive surgery has gained popularity among hip surgeons and patients. Based on early studies, the method is described as a very promising alternative, with low dislocation rates, resulting in a non-traumatic procedure and early functional return. However, complication rates arising of the recent studies raise concern about the applied technique. The aim of the study is to present the clinical results and intra- and post-operative complications of the AMIS procedure in patients with osteoarthritis of the hip, managed with total hip arthroplasty with positioning table, in a 5 years follow up. One senior hip arthroplasty surgeon performed all surgeries. Three hundred eighteen consecutive patients (195 females, 123 males) were clinically and radiologically evaluated, postoperatively 2, 6 and 12 months. Mean patient age was 69.7 years (24 to 88). There was significant improvement according to Harris-Hip Score, ODI, SF-36 scales. The mean incision length was 7.5cm (6 to 8cm). The mean operating time was calculated at 85 minutes. The patients were discharged on the second post-operative day, able to walk with partial weight bearing. One month post-operative, the patients were advised for full weight bearing walking without crutches. Intraoperative complications included two femoral perforations. Postoperative complications included two patients with femoral fractures; one with dislocation; two with superficial infections; three with wound complications; three with femoral stem aseptic loosening; one with ceramic inner fracture and two acetabular component protrusion in the same patient, among which only the last patient had reoperation in both hips. Anterior Minimal Invasive Surgery of the hip is a non-traumatic procedure, associated with reduced pain, faster recovery and no major complications, but requires higher experience level from the hip surgeon.

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Association Between Surgical Approach and Major Surgical Complications in Patients Undergoing Total Hip Arthroplasty

Pincus

Jenkinson

Paterson

et al. 2020

JAMA

126

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IMPORTANCE Controversy exists about the preferred surgical approach for total hip arthroplasty (THA).OBJECTIVE To determine whether an anterior approach is associated with lower risk of complications than either a lateral or posterior approach. DESIGN, SETTING, AND PARTICIPANTS Population-based retrospective cohort study of all adults in Ontario, Canada, who had undergone primary THA for osteoarthritis between April 1, 2015, and March 31, 2018. All patients were followed up over a 1-year period (study end date, March 31, 2019). EXPOSURES Surgical approach (anterior vs lateral/posterior) for THA. MAIN OUTCOMES AND MEASURES Major surgical complications within 1 year (composite of deep infection requiring surgery, dislocation requiring closed or open reduction, or revision surgery). Outcomes were compared among propensity-score matched groups using Cox proportional hazards regression. RESULTS Of the 30 098 patients (mean [SD] age, 67 years [10.7 years]; 16 079 women [53.4%]) who underwent THA, 2995 ( 10%) underwent the anterior approach; 21 248 (70%), the lateral approach; and 5855 (20%) the posterior approach performed at 1 of 73 hospitals by 1 of 298 surgeons. All patients were followed up for 1 year. Compared with those undergoing the lateral or posterior approach, patients undergoing an anterior approach were younger (mean age, 65 vs 67 years; standardized difference, 0.17); had lower rates of morbid obesity (4.8% vs 7.6%; standardized difference, 0.12), diabetes (14.2% vs 19.9%; standardized difference, 0.15), and hypertension (53.4% vs 62.9%; standardized difference, 0.19); and were treated by higher-volume surgeons (median range, 111 procedures; interquartile range, 69-172 vs 77 procedures, interquartile range, 50-119 in the prior year; standardized difference, 0.55). Compared with 2993 propensity-score matched patients undergoing a lateral or posterior approach, the 2993 matched patients undergoing anterior approaches had a significantly greater risk of a major surgical complication (61 patients [2%] vs 29 patients [1%]; absolute risk difference, 1.07%; 95% CI, 0.46%-1.69%; hazard ratio, 2.07; 95% CI, 1.48 to 2.88).CONCLUSIONS AND RELEVANCE Among patients undergoing total hip arthroplasty, an anterior surgical approach compared with a posterior or lateral surgical approach was associated with a small but statistically significant increased risk of major surgical complications. The findings may help inform decisions about surgical approach for hip arthroplasty, although further research is needed to understand pain and functional outcomes.

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Total hip arthroplasty through an anterior approach

Cited by 47 publications

References 88 publications

Quality of the femoral cement mantle in total hip arthroplasty using the direct anterior hip approach

Quality of the femoral cement mantle in total hip arthroplasty using the direct anterior hip approach

AMIS Total Hip Arthroplasty using traction table: 5 years follow-up

Association Between Surgical Approach and Major Surgical Complications in Patients Undergoing Total Hip Arthroplasty

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